Dissertations / Theses on the topic 'Heart Surgery Patients Medical care'
To see the other types of publications on this topic, follow the link: Heart Surgery Patients Medical care.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 42 dissertations / theses for your research on the topic 'Heart Surgery Patients Medical care.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Leung, Mei-ling, and 梁美玲. "An evidence based guideline of pre- and post operative oronasopharyngeal care for cardiac patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48335642.
Full textAbstract:
Background Nosocomial infection is a crucial problem and cause of morbidity and mortality especially in cardiac surgery settings. The risk of acquiring such infection is even higher because cardiac surgery patients require intensive care postoperatively. The phenomenon is evidenced by longer length of hospital stay and increased cost of care. Pneumonia and surgical site infections were ranked among the top three most common hospital acquired infections. The usual practice for mouth care is diluted thymol gargle solution for intubated patients after cardiac surgery in Hong Kong. No local studies examine the effect of oronasopharyngeal care on minimizing such infections. An evidence based guideline in oral and nasopharyngeal nursing care is necessary to implement in hospitals for improving patient surgical outcome.
Objective To develop an evidence based practice guideline for pre- and postoperative oronasopharyngeal care of in-patients undergoing cardiac surgery with implementation planning and discussion on evaluation.
Methods The most recent publications were searched till August 2011. Randomized controlled trials with oropharyngeal and/ or nasopharyngeal care with outcome measures on surgical site infection and/ or nosocomial pneumonia were reviewed. Essential data were extracted with quality assessed methodologically.
Results Six randomized controlled trials comparing oropharyngeal and/ or nasopharyngeal care intervention with usual care were reviewed. The studies mostly included middle-aged male patients undergoing cardiac surgery. The results showed positively of interventions on nosocomial pneumonia and surgical site infection when compared with usual care. In view of quality assessments and statistically significant findings, the proposed change that could improve surgical outcome of patients is to use chlorhexidine gluconate on oronasopharyngeal care in the guideline. It mainly carries out in in-hospital settings both by patients with education from nurses preoperatively, and by nurses postoperatively.
Conclusion Reviewed evidence shown that the oronasopharyngeal care interventions help effectively on minimizing the occurrence of nosocomial pneumonia and surgical site infections for patients undergoing heart surgery. It could be potentially adopted for nurses working in cardiac surgical ward and cardiac intensive care unit.published_or_final_version
Nursing Studies
Master
Master of Nursing
2
Ågren, Susanna. "Supportive care for patients with heart failure and their partners : A descriptive and interventional study." Doctoral thesis, Linköpings universitet, Omvårdnad, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-56232.
Full textAbstract:
Background: Having the support of a partner is essential for both health related quality of life and survival in heart failure patients. However, caring for a patient with heart failure may affect the health related quality of life, well‐being and cause a burden for the partner. The partner is expected to be responsible for the care, which may have consequences for the heart failure patient’s long‐term health and well‐being. Further research to determine health related quality of life, well‐being, caregiver burden and needs of partners is warranted as well as studies evaluating interventions targeting patient‐partner dyads. Aim: The overall aim was to describe how the life situation of patient‐partner dyads was influenced by heart failure and to determine the effects of an intervention of follow‐up with education and psychosocial support for patient‐partner dyads. Design and methods: The thesis is based on three quantitative studies and one qualitative study. The first two studies were descriptive and included 135 dyads (patient‐partner) (I, II) and the randomised intervention study included a total of 155 dyads (IV). The qualitative study had a grounded theory approach. Thirteen partners were interviewed and data analysed using constant comparative method (III). Results: Caregiver burden was perceived as moderate in 30% of the partners and the rest experienced a low caregiver burden. The patients’ physical component score of SF‐36, partners’ mental component score of SF‐36 and perceived control explained 39% of the caregiver burden (I). Patients had lower health related quality of life compared to their partners in all dimensions except in the mental health domain of SF‐36 and lower qualityadjusted life year weights compared to their partners. Mental health scores were lower in partners compared to age and gender‐matched references. All other health related quality of life scores and the quality‐adjusted life year weights were comparable between the partners and the reference group. Patients had more depressive symptoms than their partners. There was no difference in the level of perceived control or knowledge about chronic heart failure between patients and partners (II). During grounded theory analysis confirmation was identified as describing the core category of the partners’ individual needs. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among partners (III). At the three month follow‐up the dyad‐intervention had improved perceived control in patients, but not in the partners. There were no other significant differences in the control and intervention group with regard to the dyads’ health related quality of life and symptoms of depression. There were also no differences in the patients’ self‐care behaviour and partners’ experiences of caregiver burden (IV). Conclusions and implications: Partners to patients with chronic heart failure are at risk of decreased mental well‐being. One third of the partners experienced a moderate caregiver burden and was therefore at a higher risk of poor mental health and decreased perceived control. During short‐term follow‐up the intervention with education and psychosocial support to dyads (patient‐partner) improved the level of perceived control in the chronic heart failure patient group. By identifying partnersʹ needs for security, rest for mind and body, and inner strength, healthcare professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions targeting dyads have been limited in previous research. Partners need to be prepared regarding the disease process, the daily regimen, hopes for the future and responsible care providers. They also need to be confirmed because they are vital to the patients’ recovery. Further, the effects of the intervention study should also include a long‐term follow‐up as well as an evaluation of the health‐economic perspective including direct and indirect costs of care.
3
Sisterman, Kathryn, and Kathryn Sisterman. "Improving Care for Patients Hospitalized with Heart Failure." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626616.
Full textAbstract:
Background: Heart failure is a clinical syndrome occurring from the heart’s inability to effectively fill and or pump blood, it is the most common reason for admission in elderly patients. Guideline directed medical therapy refers to implementation of all class I agents to reduce patient morbidity and mortality, unless there is an appropriate contraindication. Appropriate beta blocker (BB), angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and aldosterone antagonist (AA) are recommended to be prescribed together prior to discharge for a hospital admission for decompensated heart failure with reduced ejection fraction (HFrEF). Get With The Guidelines – Heart Failure (GWTG- HF) is an online quality improvement project that assists hospitals in providing guideline directed care.
Objective: The purpose of this study was to determine if implementation of the GWTG-HF program, increases provider adherence to guideline directed medical therapy (GDMT) for patients admitted with a primary diagnosis of decompensated HFrEF at Banner University Medical Center Tucson (BUMCT).
Design: This is a quality improvement project with a pre and post test descriptive design.
Setting: BUMCT from 10/04/17 – 11/08/17
Participants: Fifty-five patients discharged with the primary diagnosis of decompensated HFrEF
Measurements: Baseline guideline adherence for a 30-day period was compared to guideline adherence after the initiation of the GWTG-HF program.
Results: The 24 patients pre intervention were compared to 31 patients post intervention. The following results were found when comparing pre and post adherence rates: BB adherence 92% versus 100%, ACEI/ARB adherence 100% versus 94%, AA adherence 67% versus 84%, and guideline directed medical therapy 58% versus 81%. There were no statistically significant differences for the pre and post adherence rates.
Conclusion: Although, there were no statistically significant differences found to support that implementation of the GWTG-HF program, increases providers adherence to GDMT for patients admitted with a primary diagnosis of decompensated HFrEF, the trends were clear. In three out of four class I agents, there was an increase in appropriate provider prescribing per the guidelines.
4
Maynard, Charles. "Blacks in the coronary artery surgery study /." Thesis, Connect to this title online; UW restricted, 1986. http://hdl.handle.net/1773/8877.
Full text
5
Cozac, JoAnn Lee. "Spouses’ experiences of having a mate in the Intensive Care Unit following coronary artery bypass graft surgery." Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/24413.
Full textAbstract:
It is generally recognized that a serious illness with concurrent hospitalization in an ICU will have an impact on family members. Few researchers, however, have described the ways in which spouses are affected when their mates are hospitalized in an ICU. Therefore, this study aimed to describe and explain the spouses' experiences of having a mate in an ICU following coronary artery bypass graft surgery.
Kleinman's conceptual framework guided the development of the research question and provided the focus for data collection and analysis. Kleinman proposes that an understanding of the client's perspective is necessary for the provision of effective health care.
A qualitative research method based on the theoretical perspective of phenomenology was used to answer the research question. The spouses' viewpoints were elicited through unstructured interviews. The sample consisted of seven spouses, four women and three men. The spouses were interviewed on two occasions, once while their mate was still in the ICU and once shortly following their mate's discharge from the ICU. A total of 13 in-depth interviews were conducted over a 3 month period.
Data were analyzed simultaneously with and following data collection. Responses that were similar were grouped together into categories. After the data were examined and sorted into categories, the researcher defined the theme that dominated each category. The themes that emerged from the data were clarified, validated, and/or rejected by the participants during subsequent interviews. As relationships between the categories were identified, the important aspects of the spouses' experiences became apparent.
The findings revealed that the spouses located the ICU experience within the context of their experience with their mate's coronary artery bypass graft surgery. The spouses understood and made sense of the ICU experience by attaching meaning to specific events that related to the entire surgical experience. They perceived the surgical experience as consisting of three distinct but interrelated phases: pre-surgery; waiting during surgery; and post-surgery. During each phase, the spouses described and explained how they reacted to and coped with each new situation. These two themes, "reaction to the situation" and "coping with the situation," appeared as threads throughout the entire surgical experience. By organizing the data in relation to phases and themes, the researcher was able to meaningfully understand and communicate the spouses' entire surgical experience.
In view of the study findings, implications for nursing practice, education and research are delineated.Applied Science, Faculty of
Nursing, School of
Graduate
6
Shaffer, Leigh Larsen. "NURSES' RESPONSE TO CARING FOR PATIENTS WHO HAVE RECEIVED A HEART TRANSPLANT." Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/276401.
Full text
7
Nilsson, Sophie, and Emelie Elwing. "Experienced reasons for low compliance in patients with heart failure." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-25641.
Full textAbstract:
Bakgrund: Att leva med hjärtsvikt innebär att leva med en allvarlig kronisk sjukdom, vilket ställer höga krav på patienten. Konsekvensen av låg följsamhet kan bli att symptomen förvärras vilket i sin tur leder till sjukhusvistelse. För att förbättra följsamheten hos dessa patienter behöver alternativa strategier lyftas fram. Som bakgrund till detta tar studien upp hjärtsvikt och dess behandling, hälsolitteracitet som begrepp och användningsområde, låg följsamhet och låg hälsolitteracitet samt sjuksköterskans omvårdnadsperspektiv. Syfte: Syftet med litteraturstudien var att undersöka upplevda orsaker till låg följsamhet hos patienter med hjärtsvikt. Metod: Studien genomfördes som en litteraturstudie med kvalitativ ansats, inriktad på patienter med hjärtsvikt och deras perspektiv. Databassökning genomfördes med blocksökningar i CINAHL och PubMed. 12 artiklar granskades med en granskningsmall för kvalitativa artiklar, utformad av SBU. En enkel form av innehållsanalys enligt Forsberg och Wengström, användes vid analysförfarandet. Resultat: Patienter upplevde sig ha svårt att förstå sin sjukdom, de kände att stort ansvar lades på dem, saknade stöd, fick bristfällig information och upplevde otydlig kommunikation med hälso- och sjukvården. De hade även svårt att ändra vanor och upplevde sig gå miste om sociala situationer till följd av känslan av den begränsning som rekommendationerna medförde. Detta ledde i sin tur till låg följsamhet. Resultatet presenterades i fyra teman: att inte förstå sin sjukdom, upplevelse av bristande stöd, upplevelse av bristande kommunikation och information och upplevelse av bristande välbefinnande. Slutsats: Resultatet visade på de svårigheter som patienter upplever i att leva med hjärtsvikt. De fyra teman diskuterades utifrån hälsolitteracitet, sjuksköterskans omvårdnadsperspektiv och personcentrerad vård. Studien lyfte fram patienters perspektiv av orsaker till låg följsamhet men även hur sjuksköterskan skulle kunna påverka patienter till ökad följsamhet. Ett personcentrerat perspektiv och kunskap om hälsolitteracitet lyfts fram som alternativa sätt att nå patienter med låg följsamhet.Background: To live with heart failure means living with a severe cronic disease, this requires a lot of the patients. The consequence of low compliance can result in worsened symptoms which leads to hospitalization. To improve patients’ compliance alternative strategies needs to be highlighted. The background in this study contains four parts: heart failure and its treatment, health literacy as a concept and its usability, low compliance and low health literacy, and a nursing perspective. Aim: The aim was to explore perceived reasons for low compliance in patients with heart failure. Method: The study was conducted as a literature review with a qualitative approach, with a focus on patients with a heart failure and their perspective. The database search was performed with searches in CINAHL and PubMed. 12 articles were reviewed with a template by SBU. A simple form of content analysis was used for analysing the articles. Result: Patients experienced that it was difficult to understand their disease, they felt a large responsibility were imposed on them, they experienced a lack of support, inadequate information and experienced inexplicit communication with the health care. Patients also experienced difficulty changing habits and to miss out on social occasions because of the limitations the recommendations imposed. All this led to low compliance. The results were presented in four themes: to not understand one’s disease, experience of a lack of support, experience of inadequate communication and information, and experience of insufficient wellbeing. Conclusion: The results show the difficulties that patients experience when living with heart failure. The four themes were discussed from a health literacy perspective, a nursing perspective and patient-centered care. The study highlights the patient perspective on reasons for low compliance but also how the nurse can influence patients to increase their compliance. Health literacy and patient-centered care are discussed as alternative ways to reach patients with low compliance.
8
Smith, Kristin K. "A comparison of objective versus subjective recording of respiratory rates in adult medical cardiac patients." free to MU campus, to others for purchase, 1998. http://wwwlib.umi.com/cr/mo/fullcit?p1392396.
Full text
9
Haghshenas, Abbas Public Health & Community Medicine Faculty of Medicine UNSW. "Negotiating norms, navigating care: the practice of culturally competent care in cardiac rehabilitation." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/32280.
Full textAbstract:
BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.
10
Bischoff, Bernhard, Sigmund Silber, Barbara M. Richartz, Lars Pieper, Jens Klotsche, and Hans-Ulrich Wittchen. "Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-106354.
Full textAbstract:
Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany.
Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications.
Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
11
Bischoff, Bernhard, Sigmund Silber, Barbara M. Richartz, Lars Pieper, Jens Klotsche, and Hans-Ulrich Wittchen. "Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany." Technische Universität Dresden, 2006. https://tud.qucosa.de/id/qucosa%3A26666.
Full textAbstract:
Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany.
Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications.
Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
12
Claridge, Jeffrey A. "The Development of SIC-IR© to Assist with Diagnosing Infections in Critically Ill Trauma Patients: Moving Beyond the Fever Workup." Cleveland, Ohio : Case Western Reserve University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1213634730.
Full text
13
Salmon, Becky A. "Differences between men and women in compliance with risk factor reduction : pre and post coronary artery bypass surgery." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/865938.
Full textAbstract:
Coronary Artery Bypass Graft(CABG) Surgery increases blood flow to the endangered myocardium but does not slow the process of atherosclerosis. The only way to slow the process of coronary artery disease is to acknowledge the risk factors present and minimize or totally eliminate them from an individual's lifestyle. Men and women respond differently to stress and lifestyle modifications. The purpose of this study was to determine if there was a difference between genders in compliance to a heart healthy lifestyle pre and post CABG surgery.Thirty men and thirty women who had CABG surgery at least one year earlier were interviewed to assess coronary artery disease risk. The procedure for the protection of human subjects were followed. The instrument used was the RISKO Heart Hazard Appraisal Tool. This instrument was developed in 1985 by the American Heart Association and scored individuals on systolic blood pressure, weight, serum cholesterol level and cigarette smoking habits. Pre-operative records were also reviewed using the same tool to assess individuals preoperative risk. The research design used was 2 x 2 repeated measures. Data were analyzed using 2 x 2 repeated measures analysis of variance (ANOVA).Two findings were discovered. First there was a statistically significant difference between men and women (F=5.82 p=0.019) with men scoring lower RISKO scores than women, indicating lower risk and better compliance to a heart healthy lifestyle, both pre- and postoperatively. Second there was a significant difference between preand postoperative RISKO scores in the total population (F=8.77 p=0.004). Postoperative RISKO scores were lower indicating an improvement in heart healthy lifestyle. There was no statistically significant difference between genders in the difference of pre- and postoperative RISKO scores (F=2.56 p<.115). The significance of this study was that it looked specifically at gender differences and assessed disparities in cardiovascular risk factors and the impact of surgery on men and women.This study found that overall, men had lower RISKO scores than women. Both genders also had improved RISKO scores postoperatively from preoperatively. No statistically significant difference between genders of the RISKO scores from preoperatively to postoperatively was found. Education needs to continue to play a big part in the cardiac rehabilitation process for both genders and specifically women need to become the target of further research and education to improve compliance to a heart healthy lifestyle.School of Nursing
14
Zhou, Haiyun, and 周海韵. "Risk factors driving ambulatory care sensitive conditions hospitalisation among elderly with chronic obstructive pulmonarydisease or heart disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47055819.
Full text
15
Quan, Millie. "A retrospective analysis of early progressive mobilization nursing interventions and early discharge among post coronary artery bypass patients." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2129.
Full textAbstract:
This project offers evidence and data to measure how progressive and sustained mobilization strategies that are implemented by nurses impact early discharge on a single stay Cardiothoracic Intensive Care Unit for patients undergoing first-time Coronary Artery Bypass Surgery (CABG) surgery.
16
Frazier, Kirsten. "Prevalence and predictors of adverse effects of medical care in patients with cleft lip and palate undergoing facial bone repairs and orthognathic surgical procedures in the United States." Thesis, University of Iowa, 2019. https://ir.uiowa.edu/etd/6735.
Full textAbstract:
BACKGROUND AND SIGNIFICANCE: Almost 15% of newborns have congenital anomalies that involve the oral and craniofacial regions, but of these congenital anomalies, cleft lip and palate and craniosynostosis are the most common. It is estimated that the incidence of cleft lip and palate is 0.664 in 1000 live births. These patients commonly have skeletal imbalances of the maxillae and mandible that require surgical and orthodontic correction. Orthodontists and oral surgeons play a critical role in identifying the necessary care and ensuring that the patient receives the best quality of care possible.
OBJECTIVES: The objective of the current study is to examine the prevalence of adverse effects of medical care and infectious complications in patients with cleft lip/palate undergoing facial bone repairs/orthognathic surgeries in the United States during the years 2012 to 2014. It will also examine the association between patient/hospital related factors and surgical outcomes (including adverse affects of surgery, incidence of infection, etc.) and how these surgical outcomes impact the hospital costs and length of stay in the hospital.
MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) is a 20% stratified probability sample of hospitalizations occurring in all acute care hospitals in the United States. It is part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ) [12]. Each hospital in this sample provides information on 20% of hospitalizations occurring during the select years. Hospital stratification is based on multiple hospital-associated variables including: hospital location, geographic region, bed size, teaching status, and ownership/control. Each hospitalization is assigned a sampling weight. Patient-related variables are also provided by the hospitals. In this study, this information is used to provide a nationally representative estimate of all hospitalizations and associated outcomes in the United States from 2012-2014.
RESULTS: This study includes all 1,785 patients with cleft lip/palate undergoing facial bone repair/orthognathic surgical procedures in the United States during the study period (2012-2014). These results confirm the hypothesis that there are a combination of patient and hospital related factors that contribute to the occurrence of adverse events and that the occurrence of these events is associated with substantial increases in hospital charges and length of hospital stay.
CONCLUSION: These study results are a national representative sample of patients with cleft lip/palate undergoing bony facial repair and orthognathic surgery. They reflect the practice patterns and hospitalization outcomes across the United States. These results can serve as a platform for future prospective controlled studies to examine the risk factors associated with adverse effects of medical care for a wide range of surgical procedures. This information is useful for clinicians, health policy makers, and patients so that they can make informed treatment and policy decisions as well as continue to improve surgical procedures and outcomes.
17
Abarca, Jacob. "The effect of beta-blocker therapy, ACE inhibitor therapy,and digoxin therapy on the risk of hospitalization and resource utilizationamong patients with congestive heart failure enrolled in a managed care organization." Thesis, The University of Arizona, 2001. http://hdl.handle.net/10150/291440.
Full textAbstract:
Congestive heart failure (CHF) represents the end-stage of all heart disease. The current incidence of CHF in the US is 550,000 cases per year and is expected to increase in the future. Therapy with β-blockers, ACE inhibitors, and digoxin has been associated with a decreased risk of all-cause hospitalization and CHF-related hospitalization in randomized clinical trials. The purpose of this study was to evaluate the effect of beta-blocker, ACE inhibitor, and digoxin therapy on these outcomes and total direct medical costs among patients with CHF enrolled in a managed care plan. Neither therapies were associated with a statistically significant reduction in CHF-related hospitalizations. ACE inhibitor therapy (180 days) was associated with a significant decrease (34.7 percent, p < 0.0001) in the risk of all-cause hospitalization and lower total direct medical costs ($2135, p < 0.001) over a one year period. The results suggest increased use of ACE inhibitors is warranted.
18
Day, Julie A. "Behavior of family practice residents in screening and treating at-risk patients for high blood cholesterol." Virtual Press, 1999. http://liblink.bsu.edu/uhtbin/catkey/1136701.
Full textAbstract:
This study was designed to answer the following research questions: "Are those at risk for coronary heart disease being screened for high blood cholesterol?" and "Are those with high blood cholesterol being treated according to the national guidelines?" The importance of early detection and treatment of high blood cholesterol is vital for preventive health care. A chart review of patient records was conducted to determine the behavior of the family practice residents. From the analysis of data it was determined that the residents screened their patients 83.0% of the time and when compared with national guidelines, treated those patients identified with high blood cholesterol 52.8% of the time. Third year residents screened their patients more (88.7%) for blood cholesterol than first (82.1%) or second (74.7%) year residents. Male residents screened a higher percent of their patients (84.8%) than female residents (75.0%).Department of Physiology and Health Science
19
Brindle, Christopher T. "Incidence and Predictor Variables of Pressure Injuries in Patients Undergoing Ventricular Assist Device and Total Artificial Heart Surgeries: An Eight-Year Retrospective Review." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/6038.
Full textAbstract:
BACKGROUND
Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.
OBJECTIVES
To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year retrospective study of all patients undergoing VAD-TAH surgery at a large academic university medical center.
METHODS
The preferred reporting items for systematic reviews and meta-analyses or PRISMA statement guided this systematic review. Quality of evidence was determined using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Two reviewers independently appraised manuscripts matching the eligibility criteria for study inclusion. Four databases including PubMed, CINAHL, Web of Science, Google Scholar, and hand searches of journals based on reference lists from included studies were utilized. Initial results of this primary search revealed zero studies that met inclusion and this search methodology was confirmed by medical librarian consultation. Therefore, a follow up retrospective study was necessary to identify incidence of PI in the VAD-TAH population. However, a secondary search, dropping keywords of VAD-TAH and instead focusing on studies of on-pump cardiac surgery and mixed surgical studies where cardiac surgery patients were included, was conducted to establish variables to guide a retrospective study of all VAD-TAH surgeries between 2010-2018. The retrospective study evaluated the incidence of pressure ulcers by case, patient and incidence density for each of the respective 1000 patient days during the study period. Univariate statistics are reported by four different VAD-TAH devices. Variables significant in bivariate analysis were entered in a stepwise logistic regression model.
RESULTS
In the systematic review, 312 articles were identified from the databases with eight additional articles from hand searches. Following abstract review, 208 were excluded for not meeting inclusion criteria or study quality metrics. 77 articles were read in full, with 61 excluded, leaving 16 articles for inclusion. 31 risk factors were identified for PI development in on-pump cardiac surgery patients with 11 risk factors which were identified as significant in multivariate analysis for inclusion in the retrospective study.
20
Uusiku, Laura Ingashipwa. "Perceptions and current practices of Namibian midwives regarding the use of the cardio-tocograph as an informative labour monitoring tool for labouring women." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/21318.
Full textAbstract:
Labour is a vital period for the labouring mothers, as it should bring with it the fulfilment of an expectation of having the baby that has been awaited. The health of the foetus which is to be born and that of the labouring mother are inextricably linked with each other which is why the labouring mother needs to be assessed and monitored carefully. The cardio-tocograph, which is a globally accepted method of diagnosis and assessment of the foetal status during labour is preferred to be used in monitoring labouring mothers, especially high- risk patients. Despite the evidence and information regarding the effectiveness of the use of the cardio-tocograph, midwives are still found not to be using it correctly, the reasons given that the women not always co-operate; do not keep the electrode and belt in place or cite the discomfort they experience from contraction. The objectives of this study were to: explore and describe the perceptions and current practice of Namibian midwives regarding the use of the cardio-tocograph as an informative labour- monitoring tool. Explore and describe how midwives working in labour wards in Namibia perceive informing laboring women of the use of the cardio-tocograph as an informative labour- monitoring tool and based on the results, develop an instruction guide for midwives working in the labour ward in intermediate hospital in Namibia that would serve as a guide on how to teach labouring women about the use of the cardio-tocograph as a labour- monitoring tool and enhance positive labor and delivery outcomes The study was conducted between May and June 2016, using a qualitative, explorative, descriptive and contextual design, following the necessary university approval and approval from other relevant authorities. The research population was midwives who work in labour wards at a public hospital in Namibia. Semi-structured interviews were used to collect data from purposively sampled participants using set criteria. A voice recorder was used to capture the interview with the permission of the participants. Seventeen midwives were interviewed of whom two were used for the pilot study. Data saturation determined the sufficient sample size. The collected data was analyzed using Tesch’s spiral method of data analysis with the assistance of an independent coder From the research findings, it emerged that midwives had varying perceptions regarding the use of the CTG machine. Midwives still perceive CTG interpretation as a challenge as a labour -monitoring tool and expressed a need for updates. Furthermore, midwives expressed the fact that they had limited communication with labouring women regarding the use of CTG. Based on the research findings and guided by Health Belief Model principles, three main guidelines were developed for midwives working in the labour ward in a public hospital in Namibia. These guidelines will serve as a tool to assist midwives in their teaching of labouring women about the use of the cardio-tocograph as a labour- monitoring tool, and the role to be played by labouring women during that monitoring period. Furthermore, recommendations for clinical nursing practice, nursing education and nursing research were developed. The researcher used literature control to ensure validation and integrity of the study. Trustworthiness, which was used to ensure rigour of the study, was guided by the principles of truth-value, transferability, dependability and confirmability. Ethical considerations were guided by the Belmont report adopting the principles of beneficence, respect for human dignity, justice and non-maleficence.
21
Hosseinipour, Milad. "Design and Development of an Intra-Ventricular Assistive Device For End Stage Congestive Heart Failure Patients: Conceptual Design." University of Toledo / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1372726495.
Full text
22
Andersson, Anna, and Anna Hardin. "Riskfaktorer för postoperativt delirium efter hjärtkirurgi : En systematisk litteraturstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-84913.
Full textAbstract:
Bakgrund: Att genomgå hjärtkirurgi kan rädda en patients liv men det kan även leda till en ökad risk att drabbas av en komplikation som postoperativt delirium. Delirium är inte ett sjukdomstillstånd utan ett tillstånd av mental förvirring som påverkar patientens uppmärksamhet, medvetenhet och kognitiva förmåga. Postoperativt delirium kan leda till många negativa konsekvenser vilket kan medföra lidande för patienten. Vården ska ha som mål att lindra patientens lidande genom att se till hela patienten i den vårdande relationen, det är det som är kärnan i vårdvetenskap. Forskning har visat att det är viktigt för patientens postoperativa återhämtning att tidigt kunna upptäcka och förebygga postoperativt delirium. Det har framkommit att intensivvårdssjuksköterskor behöver ha ökad förståelse och kunskap om ämnet för att kunna upptäcka och förebygga postoperativt delirium efter hjärtkirurgi. Syfte: Syftet med studien är att identifiera riskfaktorer som kan påverka utvecklingen av postoperativt delirium bland intensivvårdspatienter efter hjärtkirurgi. Metod: En systematisk litteraturstudie där kvantitativa artiklar har analyserats efter Bettany-Saltikov och McSherry (2016) analysmetod. Resultat: Analysen resulterade i fyra kategorier: Patientens bakgrund, Tiden i hjärt-lungmaskin, Längden av respiratorbehandling samt Komplikationer till följd av hjärtkirurgi som är riskfaktorer som visade sig påverka utvecklingen av postoperativt delirium. Slutsats: Den samlade kunskapen som föreliggande studie har givit kan ligga till grund för intensivvårdssjuksköterskor i vården av patienter med postoperativt delirium. Intensivvårdssjuksköterskor ska ha med sig i den vårdande relationen att patientens situation är komplex och att det de utsätts för kan bidra till ökat lidande för patienten. Mer forskning behövs kring riskfaktorer för postoperativt delirium och hur den mentala förvirringen påverkar patienten och dess anhöriga.Background: Heart surgery can save a patient's life but can also lead to an increased risk of suffering from a complication such as postoperative delirium. Delirium is not an illness but a state of mental confusion that affects the patient's attention, awareness and cognitive ability. Postoperative delirium can lead to many negative consequences which can cause patient suffering. Nursing care has aimed to alleviate a patient's suffering by seeing the entire patient in the caring relationship. This is the core in nursing science. Research has shown that it is important for the patient's postoperative recovery to be able to detect and prevent postoperative delirium in an early stage. It has appeared that intensive care nurses need more education and knowledge in this area in order to be able to detect and prevent postoperative delirium after heart surgery. Aim: The aim of the study is to identify risk factors that are associated with the development of postoperative delirium after heart surgery within patients in the intensive care unit. Method: A systematic literature review that analyzed quantitative articles according to a method of analysis by Bettany-Saltikov and McSherry (2016). Result: Four categories emerged from the analysis: Patients background, length of mechanical ventilation, Heart- and lung machine duration and Complications after heart surgery that were risk factors which affected the development of postoperative delirium. Conclusion: The overall knowledge that the study has provided can form a basis for intensive care nurses in the care of patients with postoperative delirium. Further research is needed on risk factors for postoperative delirium and how the mental confusion affects both the patient and relatives. More research is also needed about how postoperative delirium can be prevented.
23
Edwards, Timothy Robin. "A prospective observational study to investigate the effect of prehospital airway management strategies on mortality and morbidity of patients who experience return of spontaneous circulation post cardiac arrest and are transferred directly to regional Heart Attack Centres by the Ambulance Service." Thesis, University of Hertfordshire, 2017. http://hdl.handle.net/2299/19508.
Full textAbstract:
Introduction: The most appropriate airway management technique for use by paramedics in out-of-hospital cardiac arrest is yet to be determined and evidence relating to the influence of airway management strategy on outcome remains equivocal. In cases where return of spontaneous circulation (ROSC) occurs following out-of-hospital cardiac arrest, patients may undergo direct transfer to a specialist heart attack centre (HAC) where the post resuscitation 12 lead ECG demonstrates evidence of ST elevation myocardial infarction. To date, no studies have investigated the role of airway management strategy on outcomes in this sub-set of patients. The AMICABLE (Airway Management In Cardiac Arrest, Basic, Laryngeal mask airway, Endotracheal intubation) study therefore sought to investigate the influence of prehospital airway management strategy on outcomes in patients transferred by the ambulance service directly to a HAC post ROSC. Methods: Adults with ROSC post out-of-hospital cardiac arrest who met local criteria for transfer to a HAC were identified prospectively. Ambulance records were reviewed to determine prehospital airway management approach and collect physiological and demographic data. HAC notes were obtained to determine in-hospital course and quantify neurological outcome via the Cerebral Performance Category (CPC) scale. Neurologically intact survivors were contacted post discharge to assess quality of life via the SF-36 health survey. Statistical analyses were performed via Chi-square, Mann Whitney U test, odds ratios, and binomial logistic regression. Results: A total of 220 patients were recruited between August 2013 and August 2014, with complete outcome data available for 209. The age of patients ranged from 22-96 years and 71.3% were male (n=149). Airway management was undertaken using a supraglottic airway (SGA) in 72.7% of cases (n=152) with the remainder undergoing endotracheal intubation (ETI). There was no significant difference in the proportion of patients with good neurological outcome (CPC 1&2) between the SGA and ETI groups (p=.286). Similarly, binomial logistic regression incorporating factors known to influence outcome demonstrated no significant difference between the SGA and ETI groups (Adjusted OR 0.725, 95% CI 0.337-1.561). Clinical and demographic variables associated with good neurological outcome included the presence of a shockable rhythm (p < .001), exposure to angiography (p < .001), younger age (p < .001) and shorter time to ROSC (p < .001). Due to an inadequate response rate (25.4%, n=15) analysis of SF36 data was limited to descriptive statistics. Limitations: The study only included patients who achieved ROSC and met the criteria for direct transfer to a HAC. Results are therefore not generalisable to more heterogenous resuscitation populations. Accuracy of clinical decision making and ECG interpretation were not assessed and therefore some patients included in the study may have been inappropriately transferred to a HAC. The low SF-36 survey response rate limited the level of neurological outcome analysis that could be undertaken. Conclusion: In this study, there was no significant difference in the proportion of good neurological outcomes in patients managed with SGA versus ETI during cardiac arrest. Further research incorporating randomised controlled trials is required to provide more definitive evidence in relation to the optimal airway management strategy in out-of-hospital cardiac arrest.
24
Heriot, Jody L. "Implementation of a Beta Blocker Protocol." UNF Digital Commons, 2012. http://digitalcommons.unf.edu/etd/415.
Full textAbstract:
Background: Beta blockers are recommended by the American College of Cardiology/American Heart Association Guidelines for high and intermediate-risk cardiac patients undergoing non-cardiac surgery. Beta blockers are a class of drugs that moderate the effects of increased catecholamine levels on the heart by selectively blocking beta receptors in the heart and blood vessels, resulting in a lower heart rate and blood pressure. Beta blocker use perioperatively has been shown to reduce the risk of ischemia and infarction.
Purpose: The purpose of this project is to address beta blocker use in a group of anesthesia providers who routinely attend to high-risk and intermediate-risk cardiac patients undergoing non-cardiac surgery in a medium-sized private hospital in suburban South Florida. There are barriers to the implementation of the published guidelines for beta blocker administration, including lack of awareness of the best current practice and a lack of a formal beta blocker protocol at the institutional level.
Methods: A simple and inexpensive beta blocker protocol was implemented and evaluated by various means. Beta blocker administration practices were examined and documented prior to and after protocol implementation. Beta blocker usage was examined prior to and after protocol implementation
Findings/Implications: It was hypothesized that increased anesthesia provider awareness would lead to increased administration of perioperative beta blockers to high-risk and intermediate-risk cardiac patients undergoing non-cardiac procedures. Although there was a knowledge increase related to the new beta blocker protocol, no change in practice was observed.
25
Cohen, Sarah. "Apport et utilisation des bases de données médico-administratives dans l’étude des problématiques émergentes chez les patients adultes atteints de cardiopathie congénitale Administrative health databases for addressing emerging issues in adults with CHD: a systematic review Accuracy of claim data in the identification and classification of adults with congenital heart diseases in electronic medical records Exposure to low-dose ionizing radiation from cardiac procedures and malignancy risk in adults with congenital heart disease." Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCB228.
Full textAbstract:
Les cardiopathies congénitales (CC) sont les plus fréquentes des malformations congénitales et concernent près de 1% des naissances. Grâce aux progrès considérables de la cardiologie pédiatrique et de la chirurgie cardiaque, 90% des enfants nés avec une CC atteignent désormais l'âge adulte. Mais ces « survivants » ne sont pas guéris. Un certain nombre de complications, cardiaques et extracardiaques, attendues ou non, et de problématiques spécifiques émergent, justifiant une consommation de soins grandissante. Le besoin d’études en population a motivé l’analyse secondaire de données médico-administratives dans diverses régions du globe. L’objectif de cette thèse était d’étudier les conditions d’utilisation des bases de données médico-administratives (BDMA) et leurs applications possibles pour mieux comprendre les enjeux émergents de cette population nouvelle d’adultes avec CC (ACC). La première partie de ce travail a été de décrire de manière systématique toutes les études ayant utilisé des BDMA pour explorer spécifiquement les problématiques des patients ACC. Cette revue a montré l’intérêt de ces bases de données dans le domaine des ACC, les effectifs importants permettant d’étudier des maladies relativement rares et la disponibilité de données exhaustives sur de longues périodes d’observation autorisant l’étude de certaines complications cardiaques ou extracardiaques de survenue parfois différée chez ces patients. En France, les bases de données administratives de remboursement utilisent la Classification internationale des Maladies, dixième révision (CIM-10) dont la fiabilité pour repérer les ACC et les pathologies qui leur sont associées est inconnue dans ce contexte. La deuxième partie de ce travail avait donc pour objectif d’étudier la performance de la CIM-10 pour identifier et classer des patients ACC au sein de l’entrepôt de données de l’hôpital Européen Georges Pompidou disposant d'une unité dédiée aux ACC. La troisième partie de cette thèse rapporte un exemple concret de l’utilisation des BDMA. A partir des données de la Québec Congenital Heart Disease Database issue des BDMA du Québec, notre objectif était d’évaluer l’association entre l’exposition aux rayonnements ionisants provenant de procédures cardiaques et la survenue de cancer chez les ACC. En effet, l’amélioration de l’espérance de vie des patients avec CC et l’augmentation du recours aux modalités d’imagerie cardiaque irradiante, font craindre un effet carcinogène potentiel à long terme. Bien qu’elles n’aient pas été conçues à des fins de recherche, ce travail de thèse montre que les BDMA sont un outil particulièrement pertinent pour générer de nouvelles connaissances sur les patients ACC de par l’exhaustivité des informations disponibles, la possibilité de produire de grands échantillons et de permettre un suivi longitudinal sur de longues périodes d'observation. L’exploitation des dossiers médicaux électroniques par des méthodes de fouilles de texte pourrait alors permettre de développer et valider des algorithmes pour identifier les cas de CC dans les BDMA. En France, bien que des efforts aient été déployés pour créer un programme de collaboration multicentrique efficace, il n’existe à l’heure actuelle aucune donnée épidémiologique d’envergure concernant l’ensemble des ACC. L’analyse secondaire de ressources existantes, telles que le Système National des Données de Santé, permettrait d’établir la cohorte nationale d’ACC et d’analyser leur parcours de soins afin d’orienter au mieux l’allocation des ressourcesCongenital heart diseases (CHD) are the most common types of birth defects and affect approximately 1% of births. Ninety percent of children born with CHD reach now adulthood thanks to improvements of pediatric cardiology and cardiac surgery. These "survivors" are not definitively cured. They are prone to cardiac or extra cardiac complications and specific issues that justify an increase in consumption of healthcare. The need for population-based studies worldwide has led to secondary analyses of administrative medical databases (AMD). The objective of this thesis was to study the conditions of use of the AMD and their possible applications, specifically to understand the emerging issues of this new adult population with CHD (ACHD). The first part of this work was to systematically describe all the studies that had used AMD to specifically explore the issues of ACHD patients. This review showed the value of these databases in the field of ACHD: the large numbers of patients allows studying relatively rare diseases and the availability of comprehensive data over long periods of follow-up enables to study cardiac and extra cardiac complications even when the occurrence is delayed. In France, claim databases use the International Classification of Diseases, 10th revision (ICD-10), the reliability of which is still largely unknown in this context. The second part of this work was therefore to study the performances of ICD-10 to identify and classify ACHD patients in the data warehouse of the Georges Pompidou European Hospital which has a dedicated specialized ACHD Unit. The third part of this thesis reported a concrete example of the use of AMD. Based on the Quebec Congenital Heart Disease Database derived from Quebec’s AMD, our goal was to evaluate the association between exposure to ionizing radiation from cardiac procedures and the risk of cancer in ACHD. Indeed, the improvement in the life expectancy of patients with CHD and the increasing use of cardiac imaging modalities using ionizing radiations may have a carcinogenic effect in the long term. Although not designed for research purposes, this thesis showed that AMD are a particularly relevant tool for generating new knowledge about ACHD patients through the comprehensiveness of information, the possibility of extracting large samples of patients with a longitudinal follow-up over long periods of observation. The exploitation of electronic medical records through text mining methods could then be used to develop and validate algorithms to identify CHD patients in AMD. In France, although efforts have been made to create an effective multi-center collaborative program, there is currently no significant epidemiological data for all ACHDs. Secondary analysis of existing resources, such as the National Health Data System, would establish the national ACHD cohort and analyze their care pathway in order to guide healthcare resources allocation
26
"Fast track perioperative care for adults undergoing elective cardiac surgery." 2013. http://library.cuhk.edu.hk/record=b5884407.
Full textAbstract:
Zhu, Fang.Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 171-185).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts also in Chinese.
27
Aurand, Janice Treston. "A retrospective comparison study of two types of preoperative skin preparation in patients experiencing cardiac surgery a research report submitted in partial fulfillment ... /." 1990. http://catalog.hathitrust.org/api/volumes/oclc/68795135.html.
Full text
28
"Holistic aspects of rehabilitation post cardiac surgery in the Bonny method of guided imagery and music." University of Technology, Sydney. Faculty of Nursing, Midwifery & Health, 2003. http://hdl.handle.net/2100/238.
Full textAbstract:
This thesis has set out to investigate the role of music therapy in the form of the specialist Bonny Method of Guided Imagery and Music (GIM) with a view to exploring how meanings related to adjustment from a health crisis (such as cardiac surgery) are depicted in music-supported imagery. Factors shaping clinical interpretations of verbal and musical responses in music therapy practice are often unclear or undelineated. A systematic interpretive process relevant to clinical health care was developed using the Bonny Method of Guide Imagery and Music (GIM), providing a means for exploring the emotional difficulties of coronary bypass patients, who typically recover quickly from physical surgery but often experience residual symptoms such as depression, pain, and anxiety. The interpretive process accessed both verbal and non-verbal texts, playing them against each other in order to find significance for music therapy practice in rehabilitation. A Bonny Method of Guided Imagery and Music (GIM) series was undertaken by patients recovering from coronary artery bypass grafting (CABG), with each session audiotaped and transcribed. This narrative data was analyzed thematically, and grand themes were used to focus further intertextual (semiotic) and Jungian perspectives, in the process of deriving substantial clinical meanings. Results suggested that participants used a wide range of personal, cultural and archetypal texts to convey meanings about their health care situation, including images of the music during the therapeutic process. Clinical change in the rehabilitative process was suggested by grand themes comprising 'Looking through the frame', 'Feeling the impact', 'Spiralling into the unexpected', 'Sublime plateau', and 'Rehearsing new steps' and the further music-related grand theme of 'Sounding the changes'. This project highlights the value of GIM as a vehicle to track clinical change with cardiac patients, based on a systematic interpretive process sensitive to the interweaving verbal and nonverbal texts evident in the music therapy context.
29
Chang, Lien-Hua, and 張凌華. "Effects of back massage protocol on the state of anxiety in open-heart surgery patients in intensive care unit." Thesis, 1999. http://ndltd.ncl.edu.tw/handle/48758695083863894070.
Full textAbstract:
碩士國防醫學院
護理研究所
87
The purpose of this experimental study was to explore the effects of back massage protocol on the state of anxiety in open-heart surgery patients in intensive care unit. The subjects were selected from those in the ICU of Cardiac Surgery Service of a Taipei medical center, were assigned to either the control group or the experimental group by Block randomization. Each group consisted of 32 patients. Using single blind design, the study period was divided into rest period and massage period. During the rest period, the subjects were placed in the lateral decubitus position with eyes closed for 10 minutes, without administration of massage. During the massage period, the patients were massaged according to the protocol for 10 minutes. Each patient received one episode of massage. Subjects in the experimental group were given the massage. Subjects' heart rate, blood pressure, respiratory rate were recorded five minutes before the massage, immediately before, immediately after, three minutes after, and five minutes after the massage. To understand the alteration of the subject's anxiety state, the State Anxiety Inventory of each subject were also filled before and after the administration of massage. Data of the control group were collected accordingly at the same interval before and after the resting period. The data were analyzed according to percentage, arithmetic average, standard deviation, t-test, one way ANOVA, and Pearson's product-moment correlation. Results revealed the followings: 1. Before the experimental intervention was administrated, all subjects in the two study groups showed low level of anxiety. Their degree of anxiety varied according to the subject's basic characteristics, such as age, educational level, trait anxiety, financial resource, religion, operation modality, and number of days in ICU. 2. Back massage improved the physiological reaction index of the subjects in the experimental group towards normal values. Their average reduction of heart rate was 4.34 beats/minute, of respiratory rate was 1.94 cycle/minute, of systolic blood pressure was 9.78 mmHg, of diastolic blood pressure was 2.75 mmHg, of mean blood pressure was 4.28 mmHg. In the control group, the subjects' average reduction of heart rate was 0.22 beats/minute, of respiratory rate was 0.59 cycle/minute, of diastolic blood pressure was 1.53 mmHg, of mean blood pressure was 0.94 mmHg, and increase of systolic blood pressure was 0.88 mmHg. The difference of the variables in these two groups has statistical significance (P< .05). Back massage protocol has achieved its effectiveness of anxiety reduction, and the improvement of heart rate and systolic blood pressure remained five minutes after the massage. The back massage protocol reduced the anxiety index of these patients by 7.81 points, significantly improved the state of anxiety of patients in ICU. On the other hand, the average index of the State Anxiety of the control group increased by 1.97 points. The difference of State Anxiety of these two groups also achieved statistical significance(P< .001). Back massage protocol has achieved its effectiveness of anxiety reduction. In comparing each individual sets of point under different contents of the State Anxiety Inventory. We found the four most significant changes, after back massage ,were ranked as〝I feel comfortable〞, 〝I feel pleasant〞, 〝I feel content〞, and〝I feel calm〞. These changes indicated that back massage protocol improved significantly patients' state of comfort, calmness, and content. This study also disclosed that back massage protocol might improve the relationship between nurses and patients quickly. Through this non-verbal communication, nurse and patient may care for each other with more confidence. 3. After back massage , the anxious effects of the subjects were affected by subjects' basic characteristics, such as age, trait anxiety, and postoperative days in ICU. 4. The change of State Anxiety Index was positively correlated with the change of physical indicators: heart rate, respiratory rate, and systolic blood pressure (P< .05). The correlation coefficients were 0.269, 0.264, and 0.371, respectively.
30
Bischof, Janet Revay. "A comparison of quality of life in adult patients with heart failure in two medical settings a heart failure clinic and a physician practice /." 2006. http://etd1.library.duq.edu/theses/available/etd-11162006-093836/.
Full text
31
Tsai, Hui-Chuang, and 蔡惠庄. "The Differences of Medical Resource Utilization and Quality of Care between Traditional Surgery and Minimally Invasive Surgery among Patients with Spinal Stenosis." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/e6q2k8.
Full textAbstract:
碩士義守大學
醫務管理學系
105
OBJECTIVE. Part of aging process, lumbar spinal stenosis (LSS) is the most common reason for degenerative changes with the lumbar column in elderly population. Lumbar spondylosis might result in mechanical back pain of various degrees, claudicant symptoms, reduced mobility and poor quality of life. Operative intervention is considered when the severely pain is not relieved by non-operative treatment. Open surgery (OS) is the surgical approach conventionally used for lumbar stenosis. However, greater change in multifidus, greater muscle damage and functional disability in terms of post-operative complications are frequently seen. In recent years, minimally invasive (MIS) treatment for decompression has become widely practiced for achieving effective operation and reducing approach related complications. It is predictable that medical resource utilization would be impacted with the aging population. The purposes of this research were: 1) to describe the distribution of selective LSS patients receiving operative intervention of different surgical approaches (MIS vs. OS) at our institution,2) to explore the quality of care of the above-mentioned patients,and 3) to analyze the medical resource utilization of the above-mentioned patients’。 METHODS. This is a retrospective chart review within a regional teaching hospital of patients underwent operative interventions (MIS vs. OS) for LSS (ICD-9 diagnosis code: 724.2) from January to December 2016.Complications after surgery as well as immediate re-operation for any reason were defined as indicators to quality of care, in addition, anesthesia duration, operation duration, and hospital length of stay were noted to define the medical resource utilization. All these parameters were used to evaluate the differences Between MIS and OS groups. Ninety patients (44 in the MIS group and 46 in the OS group) were further reviewed to better characterize the sample. RESULTS. No patient developed any post-operative complication.No significant between group differences in terms of the average anesthesia duration and average operation duration were found. However, average length of hospital stay for the patients receiving OS was significantly higher than those who receiving MIS. CONCLUSION. Neurosurgical intervention is safe for patients with LSS.Postoperative complication rates associated with these procedures are very low in the early postoperative period. The results warrant a further study with much bigger scale to evaluate the minimally invasive procedures which might reduce the hospital stay related resource utilization.
32
Liang, Ying, and 梁穎. "THE QUALITY OUTCOMES AND MEDICAL CARE EXPENDITURE OF THE CLINICAL PATHWAYS APPLICATION FOR BREAST CANCER SURGERY PATIENTS." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/90785386839209273200.
Full textAbstract:
碩士國立台北護理學院
醫護管理研究所
90
The purpose of this study is to evaluate the result of quality and the medical care expenditure in the clinical pathways application for breast cancer surgery patients. The period of hospitalization（length of stay）, medical care expenditure cost reduction and the 14 day-readmission rate were obtained from 3 phase. It representing phase 0（before the implementing clinical pathways）, phase 1（initial phase）, phase 2（mature phase）. The total individual cases in our study were459. The data were analyzed to compare the difference of quality result and the medical care expenditure in 3 schedules. The result shows the length of stay (hospitalization period) was from an average of 11 days to 5 days. The 14 day readmission case in our research was 29 cases 8 cases happened before and 21 cases were after the clinical pathways application, follow up by 29 cases, we found 26 cases were planed admission for advance treatment. So we need improve our discharge plan and teaching method-the drainage tube, wound care. Breast cancer patient care must follow up by long term. The expenditure of medical care were tremendous decrease, from an average N.T.$77,500 to 44,500, per case reduction is about N.Y.$33,000, the breast cancer patient’s hospitalization were shorter and the reduction of medical care expenditure cost. It. was proved by implementing clinical pathways surgery. And 14 day-readmission rate does not increase.
33
Gojo, Mawande Khayalethu Edson. "Investigation of acute systemic inflammatory response and myocardial injury after cardiac surgery in patients infected with human immunodeficiency virus." Thesis, 2016. http://hdl.handle.net/10321/2577.
Full textAbstract:
Submitted in fulfillment of the requirements for the degree of Masters of Health Sciences in Clinical Technology, Durban University of Technology, Durban, South Africa, 2016.Introduction: The immediate post-cardiopulmonary bypass (CPB) immune responses and organ injuries in immune- compromised patients remain poorly documented. We conducted a prospective clinical study to determine whether or not human immunodeficiency virus (HIV) seropositive patients generate higher acute systemic inflammatory response and suffer greater myocardial injury, compared to HIV seronegative patients. Methodology: Sixty-one consecutive patients i.e. Thirty HIV seropositive patients and Thirty-one seronegative, undergoing elective cardiac valve(s) replacement were enrolled, over a period of nine months from a single center hospital, after informed consent was acquired. The C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) were used as biomarkers of acute inflammatory response, and cardiac troponin I (cTnI) as a biomarker for measuring postoperative myocardial injury. Single tests were measured preoperatively and postoperatively, in both groups, and these were compared and correlated to perioperative events and CPB parameters. Results: The mean age group was similar between the HIV seropositive and negative group (37.8 and 37.1 years, respectively). Preoperatively both groups had relatively equal CRP levels (p=0.388), ESR levels (p=0.817) and cTnI (p=0.489). The CPB events and durations were significantly different between the two groups, CPB duration (p=0.021). Other CPB events include, clamp aortic duration (p=0.026), CPB blood transfusion (p=0.013), CPB total urine output (p=0.035) and CPB peak lactate (p=0.040). Postoperatively we observed significant increased biomarkers level in both groups, with no significant difference between the groups: mean CRP (p=0.115), mean ESR (p=0.214) and cTnI (p=0.363). We observed a significant negative correlation between the mean change in CRP levels and mechanical ventilation (r=- 0.548, p=0.002) in the seropositive group, but not in the uninfected group (r=0.025, p=0.893). The correlation between the difference in CRP and ICU stay was not significant between in both group (r=-0.231, p=0.229 and r=0.25, p=0.975, respectively). A significant positive correlation between postoperative cTnI and the inotropic support duration (r=0.384, p=0.040) was seen in the seropositive groups, but not in the negative group (r=0.092, p=0.622). Furthermore we observed a significant drop in CD4 cells postoperatively (p=<0.001) in the HIV seropositive group. Antiretroviral treatment appeared to influence the degree of change in CD4 cells postoperatively. Conclusion: We conclude that HIV positive patients’ postoperative reactions to cardiac surgery supported by CPB are similar to those of HIV seronegetive patients. We further report non-paralleling correlations between the biomarkers and perioperative events; however these do not seem to affect the overall outcomes between the two groups.
M
34
Sousa, Bárbara Angélico Choupina de Melo e. "Evaluation of Glasgow Coma Scale after non-cardiac and non-neurological surgery among intensive care patients." Master's thesis, 2017. https://hdl.handle.net/10216/105206.
Full text
35
Sousa, Bárbara Angélico Choupina de Melo e. "Evaluation of Glasgow Coma Scale after non-cardiac and non-neurological surgery among intensive care patients." Dissertação, 2017. https://repositorio-aberto.up.pt/handle/10216/105206.
Full text
36
Sousa, José Maria Tourais Matos. "Effectiveness of Non-Invasive Home Telemonitoring in Outpatient Care for Patients with Heart Failure: A Systematic Review." Master's thesis, 2018. https://hdl.handle.net/10216/114307.
Full textAbstract:
Introdução: O papel da telemonitorização não-invasiva (NIHT) no tratamento de pacientes com insuficiência cardíaca (HF) está tudo menos estabelecido. Os especialistas da área mantêm-se em divergência e a literatura é discrepante. No entanto, não está claro se os recentes avanços tecnológicos tenham habilitado a NIHT suficientemente para afirmar a sua posição no tratamento da HF. O nosso objetivo foi avaliar sistematicamente a evidência cientifica sobre a eficácia desta intervenção.
Métodos: Realizamos uma revisão sistemática e meta-análise de ensaios clínicos randomizados sobre o efeito da NIHT sobre o tratamento da IC, em relação à mortalidade, internações e qualidade de vida. Pesquisamos quatro bancos de dados eletrônicos até setembro de 2017 sem restrições de idiomas, revisamos referências de artigos relevantes e contatamos especialistas.
Resultados: De 1362 artigos identificados, 18 foram incluídos. A NIHT reduziu a mortalidade por todas as causas (OR 0,81, IC 95% 0,68 a 0,98; participantes = 4426; estudos = 16; I2 = 20%) e hospitalizações relacionadas com a insuficiência cardíaca (OR 0,66; IC 95%: 0,54 a 0,82; participantes = 1954; estudos = 10; I2 = 45%). NIHT não demonstrou eficácia na redução de hospitalizações de todas as causas (OR 1,08, IC 95% 0,94 a 1,24, participantes = 3702; estudos = 10; I2 = 39%) ou mortalidade cardiovascular (OR 0,71, IC 95%: 0,49 a 1,05; participantes = 1386; estudos = 6; I2 = 0%).
Conclusão: Os ensaios clínicos randomizados apoiam o uso da NIHT como estratégia para reduzir hospitalizações cardiovasculares e mortalidade em pacientes com insuficiência cardíaca.Introduction: The role of non-invasive home telemonitoring (NIHT) in the treatment of patients with heart failure (HF) is all but established. Field specialists are left in disagreement and the literature is conflicting. However it remains unclear if recent technological advances have empowered NIHT sufficiently to affirm a position in the management of HF. Our aim was to systematically review the evidence about the efficacy of this intervention. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials on the effect of NIHT on the treatment of HF, in regards to the mortality, hospitalizations and quality of life. We searched four electronic databases up to September 2017 without language restrictions, reviewed references of relevant articles and contacted experts. Results: Of 1362 articles identified, 18 were included. NIHT reduced all-cause mortality (OR 0.81, 95% CI 0.68 to 0.98; participants = 4426; studies = 16; I2 = 20%) and heart failure-related hospitalizations (OR 0.66, 95% CI 0.54 to 0.82; participants = 1954; studies = 10; I2 = 45%). NIHT failed to demonstrate effectiveness in reducing either all-cause hospitalizations (OR 1.08, 95% CI 0.94 to 1.24; participants = 3702; studies = 10; I2 = 39%) or CV-mortality (OR 0.71, 95% CI 0.49 to 1.05; participants = 1386; studies = 6; I2 = 0%). Conclusion: Randomized controlled trials support the use of NIHT as a strategy to reduce cardiovascular hospitalizations and mortality in patients with HF.
37
Sousa, José Maria Tourais Matos. "Effectiveness of Non-Invasive Home Telemonitoring in Outpatient Care for Patients with Heart Failure: A Systematic Review." Dissertação, 2018. https://repositorio-aberto.up.pt/handle/10216/114307.
Full textAbstract:
Introdução: O papel da telemonitorização não-invasiva (NIHT) no tratamento de pacientes com insuficiência cardíaca (HF) está tudo menos estabelecido. Os especialistas da área mantêm-se em divergência e a literatura é discrepante. No entanto, não está claro se os recentes avanços tecnológicos tenham habilitado a NIHT suficientemente para afirmar a sua posição no tratamento da HF. O nosso objetivo foi avaliar sistematicamente a evidência cientifica sobre a eficácia desta intervenção.Métodos: Realizamos uma revisão sistemática e meta-análise de ensaios clínicos randomizados sobre o efeito da NIHT sobre o tratamento da IC, em relação à mortalidade, internações e qualidade de vida. Pesquisamos quatro bancos de dados eletrônicos até setembro de 2017 sem restrições de idiomas, revisamos referências de artigos relevantes e contatamos especialistas.Resultados: De 1362 artigos identificados, 18 foram incluídos. A NIHT reduziu a mortalidade por todas as causas (OR 0,81, IC 95% 0,68 a 0,98; participantes = 4426; estudos = 16; I2 = 20%) e hospitalizações relacionadas com a insuficiência cardíaca (OR 0,66; IC 95%: 0,54 a 0,82; participantes = 1954; estudos = 10; I2 = 45%). NIHT não demonstrou eficácia na redução de hospitalizações de todas as causas (OR 1,08, IC 95% 0,94 a 1,24, participantes = 3702; estudos = 10; I2 = 39%) ou mortalidade cardiovascular (OR 0,71, IC 95%: 0,49 a 1,05; participantes = 1386; estudos = 6; I2 = 0%).Conclusão: Os ensaios clínicos randomizados apoiam o uso da NIHT como estratégia para reduzir hospitalizações cardiovasculares e mortalidade em pacientes com insuficiência cardíaca.Introduction: The role of non-invasive home telemonitoring (NIHT) in the treatment of patients with heart failure (HF) is all but established. Field specialists are left in disagreement and the literature is conflicting. However it remains unclear if recent technological advances have empowered NIHT sufficiently to affirm a position in the management of HF. Our aim was to systematically review the evidence about the efficacy of this intervention. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials on the effect of NIHT on the treatment of HF, in regards to the mortality, hospitalizations and quality of life. We searched four electronic databases up to September 2017 without language restrictions, reviewed references of relevant articles and contacted experts. Results: Of 1362 articles identified, 18 were included. NIHT reduced all-cause mortality (OR 0.81, 95% CI 0.68 to 0.98; participants = 4426; studies = 16; I2 = 20%) and heart failure-related hospitalizations (OR 0.66, 95% CI 0.54 to 0.82; participants = 1954; studies = 10; I2 = 45%). NIHT failed to demonstrate effectiveness in reducing either all-cause hospitalizations (OR 1.08, 95% CI 0.94 to 1.24; participants = 3702; studies = 10; I2 = 39%) or CV-mortality (OR 0.71, 95% CI 0.49 to 1.05; participants = 1386; studies = 6; I2 = 0%).Conclusion: Randomized controlled trials support the use of NIHT as a strategy to reduce cardiovascular hospitalizations and mortality in patients with HF.
38
Shen, Yiwen. "Empirical Modeling and Applications in Financial Economics and Healthcare Management." Thesis, 2021. https://doi.org/10.7916/d8-42a1-0h25.
Full textAbstract:
With increased availability of data in various fields, researchers often need to combine efficient empirical methods with innovative analytical modeling techniques to make data-driven decisions and gain managerial insights from the large-scale raw data. In light of this, my thesis combines empirical methods and analytical modeling to study several data-related problems in the fields of financial economics and healthcare management. The first two parts of the thesis focus on two topics in financial economics: the role of dynamic information in asset pricing and the link between index-based investment and intraday stock dynamics. The last two parts of the thesis study the ICU admission decisions and cardiac surgery scheduling using data from different hospital units.
The first part of the thesis focuses on the role of information in financial market. As a fundamental topic in asset pricing, information is known to play an important role in determining asset prices and market volatility. In most of the existing literature, the information environment, i.e., the amount of knowable information, is assumed to be fixed and independent of investor's choice. However, in a dynamic market, the level of available information can vary substantially due to changes in technology and regulations. On the other hand, rational news producers may respond to investors' demand for information. Such effects are commonly seen in the reality, but are less studied in the literature. To bridge this gap, we develop a model of investor information choices and asset prices where the availability of information about fundamentals is time-varying. A competitive research sector produces more information when more investors are willing to pay for that research. This feedback, from investor willingness to pay for information to more information production, generates two regimes in equilibrium, one having high prices and low volatility, the other the opposite. Information dynamics move the market between regimes, creating large price drops even with no change in fundamentals. In our calibration, the model suggests an important role for information dynamics in financial crises.
In the second part of this thesis, we investigate how the growth of index-based investing impacts the intraday stock dynamics using a large high-frequency dataset, which consists of 1-second level trade data for all S&P 500 constituents from 2004 to 2018 (500GB). We estimate intraday trading volume, volatility, correlation, and beta using estimators that are statistically efficient under market microstructure noise and observation asynchronicity. We find the intraday patterns indeed change substantially over time. For example, in the recent decade, the trading volume and correlation significantly increase at the end of trading session; the betas of different stocks start dispersed in the morning, but generally move towards one during the day. Besides, the daily dispersion in trading volume is high at the market open and low near the market close. These intraday patterns demonstrate the implication of the growth of index-based strategies and the active-open, passive-close intraday trading profile. We theoretically support our interpretation via a market impact model with time-varying liquidity provision from both single-stock and index-fund investors.
In the third part of the thesis, we study the intensive care units (ICUs) admission decisions in a large hospital system. In the case of ICUs, which provide the highest level of care for the most severe patients, it is known that admission rates of some patients decrease as occupancy increases. It is also known that, for at least some conditions, ICU admission is not just a function of patients’ illness, and that a significant proportion of the variation in ICU admission rates is due to hospital, not patient, factors. To understand such variation, we employ two years of data from patients admitted to 21 Kaiser Permanente Northern California ICUs from the ED. We quantify the variation in ICU admission from the ED under varying degrees of ICU and ED occupancy. We find that substantial heterogeneity in admission rates is present, and that it cannot be explained either by patient factors or occupancy levels alone. We use a structural model to understand the extent that intertemporal externalities could account for some of this variation. Using counterfactual simulations, we find that, if hospitals had more information regarding their behaviors, and if it were possible to alter hospital admission processes to incorporate such information, hospitals could reduce their ICU congestion in a safe way.
The last part of the thesis focuses on the impact of system workload on service time and quality in the context of cardiac surgeries. Using a detailed data set of more than 5,600 cardiac surgeries in a large hospital, we quantify how surgeon's daily workload level (e.g., number of surgeries) affects surgery duration and patient outcomes. To handle the endogeneity of surgeon's daily workload, we construct instrument variables using hospital operational factors, including the block schedule of surgeons. We find high daily workload of surgeons is associated with longer incision times and worse patient outcomes. Specifically, increased daily workload of surgeons leads to longer post-surgery length-of-stay in ICU and hospital, as well as higher likelihoods of reoperation and readmission for their patients. These results highlight the potential negative impact of surgeon's fatigue under long working hours. We then develop a surgery scheduling model that incorporates the effects of surgeon's daily workload levels.
39
Hsin, Liu Wei, and 劉維欣. "The effect of the preparation for ICU admission on the health care needs and anxiety for families and their patients undergoing heart surgery." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/05517088271895616509.
Full textAbstract:
碩士國防醫學院
護理研究所
101
Background:When patients undergo cardiac surgery, they and their families do not usually expect the complicated postoperative condition and invasive monitoring that they will experience . In addition many studies have documented that Intensive Care Unit (ICU) patients have physical and emotional needs. However, the nurses in the ICU often underestimate the needs of patients and families. When ICU nurses provide care to this group of patients, the nurses should not only consider routine nursing care but also pay more attention to patients and families satisfaction. Purpose: The purpose was to meet patients and families individual needs, reduce anxiety, and increase satisfaction. Method: This quasi-experimental pretest-posttest study.The research was carried out at a cardiac surgical ward in the medical center located in the north Taiwan from 1 March to 30 April 2013. Participants(N=64) were conveniently sampled and divided into experimental and comparison groups after informed consent. After usual pre-operative patient education, the intervention group received further detailed about procedures after surgery information ICU. ICU patient’s health care demand inventory, critical care family needs inventory, and Beck anxiety inventory are applied for pre-operative and post-operative evaluation. The statistical analysis between two groups was conducted with the generalized estimating equation. Results:Patients satisfaction rate of health care demand in the intervention group 31% higher than in the comparison group(p < .001). The patient’s and families’ anxiety in the experimental group was much lower than in the comparison group (Patient:p<.05; Families: p<.01). Families needs did differ significantly between groups. Conclusion:Modified pre-operative patient education program for cardiac surgical patients provided by ICU nurses significantly increased satisfaction of patients and reduce both patients and families anxiety. These results strongly suggest that ICU nurses educate patients before cardiac surgery to satisfy their needs in the ICU.
40
Pei-Jean, Sung, and 宋佩珍. "Effects of Respiratory Sinus Arrhythmia Biofeedback on Imporving Anxiety, Depression, Acute Stress Symptoms, and Heart Rate Variability in Patients with Coronary Artery Bypass Graft Surgery and Post Intensive Care Unit Care." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/93746151155450661557.
Full textAbstract:
碩士國防醫學院
護理研究所
101
Abstract Background: Cardiovascular diseases are the second leading causes of beath. Coronary artery occlusion induced ischemic heart diseases are the half of death caused by heart diseases. Coronary Artery Bypass Graft surgery. (CABG) has become the main treatment of Coronary Arterial Disease(CAD). However, the high-risk surgical procedure and ICU admission would bring a tremendous stressful experience for these patients, and further led to high mortality and recurrence in this population. Previous study found that RSA biofeedback can stabilize autonomic nervous system, increase heart rate variability (HRV) and decrease negative psychological symptoms. Goal:This is an experimental study design. To test the effect of RSA biofeedback on improving the anxiety, depression, acute stress disorder symptoms, and HRV. Thereby reducing readmission rates, disease recurrence rate and mortality in patients with CABG and post ICU care. Method: Subjects were recruited from a cardiac surgical unit in one medical center in north of Taiwan. Thirty-four patients met the inclusion criteria, who had the first CABG surgery and experienced ICU care, were randomly assigned to the experimental group (N=18), and the control group (N=16). The experimental group received five sessions trainning of RSA biofeedback in five consecutive days, but the control group, received the normal daily routing care. The structured questionnaires including ASDS-Chinese version, Beck Anxiety Inventory- Chinese version, Beck Depression Inventory II- Chinese version and Biotrace (Mind Media B.V.-NeXus-10, Netherlands) were used to evaluate subjectts’ anxiety, depression, acute stress disorder symptoms, HRV, finger temperature, and Galvanic Skin Response(GSR) pre- and post-training. However, there were 3 subjects dropout from both groups because of early discharge or disease progression, and 7 subjects with post-inculsion arrhythmia were excluded, Finally, a total 21 subjects were included in the analysis,in which 13 subjects were in the experimental group, and 8 subjects were in the control group. The data were analyzed by Independent t-test, Chi-square test, Pearson correlation analysis and paired sample t test for testing the homogeneity between the two groups and testing the effect of RSA biofeedback on the ASD, anxiety, depression, and HRV in the experimental group. Results：1.The subjects in the experimental group reported more significant reduction in symptoms of anxiety, depression, ASD than who were in the control group; 2.The finger temperature and Galvanic Skin Response in the experimental group were more increased than that in the control group; 3. the changes in HRV of normalized LF, normalized HF and LF/HF over time were significant differences in the experimental group,but were significantly different in the control group. Conclusion:The RSA biofeedback can effectively relieve the anxiety, depression, and acute stress disorder symptoms, and increased the finger temperature and GSR. But, only normalized LF, normalized HF, LF / HF significantly different, which may be of the number of cases and lack of RSA biofeedback training time, CABG surgery itself caused by physiological change for patients with first CABG Surgery and experienced ICU care. Key words:RSA biofeedback, acute stress disorder, anxiety, depression, heart rate variability.
41
Chang, Hsing-Li, and 張幸俐. "The Related Factors of Self-Care Demands of Patients with Coronary Artery Bypass Graft Surgery: An Example of a Medical Center in Central Taiwan." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/gr7c77.
Full textAbstract:
碩士中臺科技大學
護理系碩士班
101
The study aims at analyzing related factors of self-care demands of patients with coronary artery bypass graft surgery. This is a descriptive study with the purposive sampling method. Subjects of the study are patients transferred to wards in stable conditions after a coronary artery bypass graft surgery in a medical center in central Taiwan. The interview was carried out upon patients' consent and was based on a self-designed and structured questionnaire, which covers demographic variables, characteristics of conditions and surgery, and self-care demands. Consistency of the questionnaire measured with Cronbach’s Alpha coefficients is 0.957 for preventing infection, 0.878 for healthy life and 0.834 for information. In total, 82 valid questionnaires were collected from July 2012 to January 2013. The collected data were input into an Excel file and were then analyzed with SPSS version 18.0. Results show that: 1. The subjects have an average age of 63.76, mostly male with educational background of elementary school. Their average score for cardiac surgery risk as assessed is 5.56 (moderately risky). 2. Standardized score for overall self-care demands is 81.6. In the order of desirability for self-care demands according to the subjects, "preventing infection" has the highest score of 82.6; score for "information" is 81.8; and that for "healthy life" is 81.0. 3. For different surgical methods, self-care demands have significant difference in terms of information for "medicine instructions" (p＜.05): the demands of those having "da Vinci System operation" are significantly higher than those with "median sternotomy". 4. For different accessory equipment, self-care demands have significant difference in terms of "healthy food": the demands of those using off-pump machines are significantly higher than those using on-pump one (p＜.05). 5. Number of bypassed vessels is negatively related to "complications" (r = - 0.282, p = .010); left ventricular ejection fraction is positively related to "cardiac rehabilitation exercise" of the aspect of healthy life (r = 0.224, p = .043) and "medicine instructions" of the aspect of information. 6. Hierarchical regression analysis of sum of variables of all the above major factors affecting self-care demands shows that there is no significant difference in self-care demands in terms of personal backgrounds, characteristics of the condition and surgery and score for cardiac surgery risk as assessed, suggesting that the patients have same level of self-care demands regardless of their backgrounds, surgical methods and degree of seriousness of their conditions. Recommendations based on the study are that nurses should have a set of complete health education programs on self-care demands in areas like preventing infections, healthy life and information for patients had coronary artery bypass graft surgery and the health education should be detail enough regardless of patients' backgrounds, surgical methods and degree of seriousness of their conditions.
42
Hwang, Nan-Ching, and 黃南競. "A Study on Constructing a Home Care Medical Decision Making System Using Micro Telecare System: Post-Surgery Patients With Abdominal Aortic Aneurysm As an Example." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/r252zy.
Full textAbstract:
博士淡江大學
資訊工程學系博士班
102
Statistics from Taiwan''s Department of Health show that, among the 10 leading causes of death in 2010, heart disease and cerebrovascular disease in cardiovascular disease came in second and third place. Confronted by an aging society, the elderly population is rising, and cardiovascular disease is an disease that can no longer be ignored. A kind of cardiovascular disease, the aneurysm can be classified into 5 types, of which renal artery abdominal aortic aneurysm is most common and accounts for approximately 80% of all aortic aneurysms. In the surgical treatment of aortic aneurysms, traditional laparotomy and artificial vascular stent placement surgery are widely accepted. In order to let patients have a better post-surgery life, measuring physiological parameters at their own home is becoming an important trend. But if professional judgment of the service can be added, it would be of help to disease prevention. And offering a Telehealth system with remote monitoring capability is one of the good application tools. In this study, we a non-invasive micro Telecare system that integrates proactive tiny signs of life and activity sensors and variety of communication channels. This system allows abdominal aortic aneurysm patients to go outdoors and have a safer and securer post-surgery life. This also can reduce regrets due to no timely assistance from healthcare manpower or family. Besides, under continued long-term physiological monitoring, non-essential follow-ups can be spared, which can save considerable travel time and healthcare costs.